CDC

Use and Acceptance of HPV Vaccine Still a Work in Progress

Source: National Cancer Institute

A bellwether moment in the history of cancer prevention came in 2006 when the Food and Drug Administration (FDA) approved the first vaccine to prevent cervical cancer. The vaccine, Gardasil, protects against the two primary cancer-causing, or oncogenic, types of the human papillomavirus (HPV)—HPV-16 and HPV-18. These types are responsible for more than 70 percent of cervical cancer cases worldwide. In 2009, the FDA approved a second HPV vaccine, Cervarix, which also targets HPV-16 and HPV-18.

Gardasil and Cervarix, vaccines that protect against the two primary cancer-causing types of the human papillomavirus (HPV), entail a three-shot regimen, with each dose delivered several months apart.

But what has transpired since these two vaccines received regulatory blessing in the United States has reaffirmed something that cancer and public health researchers have appreciated for some time: The translation of basic research to the clinic doesn’t end with FDA approval of a new drug or treatment. In many respects, FDA approval is just a beginning.

In March 2007, the CDC’s Advisory Committee on Immunization Practices (ACIP) gave its strongest recommendation for HPV vaccination for females ages 9 to 26, which is the FDA-approved indication for Gardasil. Cervarix is approved for females ages 10 to 25. Both vaccines entail a three-shot regimen, with the doses delivered several months apart. According to the most recent data, only 44 percent of adolescent girls 13 to 17 years of age have received at least one dose of the vaccine. Completion rates for the three-shot regimen are substantially lower, with only 27 percent of adolescent girls receiving all three doses.

“Uptake is low because of problems with policy, problems with clinical encounters, and problems with parents’ decisions,” said Dr. Noel Brewer of the University of North Carolina Gillings School of Global Public Health. These obstacles are by no means insurmountable, but addressing each obstacle will take time, patience, and research, say investigators working in this area. And a good bit of that research can be grouped into two categories: missed opportunities and teachable moments.

HPV Vaccines for Boys

Gardasil has also been approved by the FDA for use in boys. The initial approval in boys, in 2009, was for the prevention of genital warts because Gardasil, unlike Cervarix, also protects against two other HPV types—HPV-6 and HPV-11—that are the primary cause of genital warts.

But, in December 2010, the approval was expanded to include the prevention of anal cancer, another disease associated with HPV-16 and HPV-18 infection. Because the approval for boys is so recent, this article focuses only on the uptake of the HPV vaccines by females.

No vaccine has an uptake rate of 100 percent, although when vaccines are mandated, such as those required for school attendance, vaccination rates can reach 80 to 90 percent. Although there has been a flurry of legislative activity at the state level since Gardasil was approved in 2006, only Virginia and Washington, DC, require HPV vaccination for school entry, and Virginia’s law includes a provision that allows parents to opt out of the requirement.

Based on surveys that Dr. Brewer and his colleagues have conducted, concerns that HPV vaccination will encourage sexual activity seem to have had little to do with the lagging vaccination rates. Nor, he continued, has uptake of the vaccines been substantially affected by the antivaccine movement that was spurred by fears raised about the now-discredited links between autism and childhood vaccines.

In general, concerns about safety and other issues with vaccines “are not specific to the HPV vaccine,” said Dr. Gregory Zimet of the Indiana University Melvin and Bren Simon Cancer Center. “There is a general vaccine hesitancy that affects a lot of parents.”

The Power of Physician Recommendations

Factors affecting vaccination rates have “definitely been a mixed bag,” agreed Veronica Chollette, who oversees a portfolio of HPV vaccine-related research in NCI’s Division of Cancer Control and Population Sciences. Cultural issues, lack of awareness, and, initially, reimbursement issues that limited the amount of vaccine physicians were willing to keep in stock have all played a role, she noted.

Physician encounters have also had an effect in an entirely different way. In a study published last year, less than 60 percent of pediatricians reported that they strongly recommended HPV vaccination for their 11- to 12-year-old patients. Another study of women ages 19 to 26 showed that, among women whose doctors did not recommend HPV vaccination, only 5 percent were vaccinated. Among those who did receive a recommendation, 85 percent were vaccinated.

“Pediatricians and family physicians are missing a lot of opportunities when patients come in for office visits,” said Dr. Brewer. Part of the problem, he added, is a systemic issue: health care providers are not flagging the charts of patients who are eligible for the vaccines or using reminder systems in electronic medical records, for example.

Interactions with the health care system drop precipitously once kids reach adolescence, he continued. “So it’s a big deal to miss those chances.”

Sociocultural factors are also important to consider. A study conducted in Appalachia, for example, found that conservative religious beliefs and a mistrust of outside influences played a prominent role in the vaccines’ acceptability. Meanwhile, studies of college-age women have shown that, even when receipt of the initial HPV vaccine dose was similar among white and black women, completion rates for all three doses were substantially lower among black women.

The disparity is noteworthy, Chollette stressed, because black women and Hispanic women have significantly higher cervical cancer incidence and death rates than white women.

In some cases insurance status can affect vaccine uptake and adherence. But, because federal and state-level programs, such as the Vaccines for Children program, make the vaccines available for free or for a minimal charge to low-income children, it may not contribute as much to the disparities in vaccination rates, said Dr. Ruth Carlos of the University of Michigan Medical Center. In fact, a higher percentage of 13- to 17-year-old girls from families below the poverty line have received at least one dose of the vaccine compared with girls from families above the poverty line (52 percent versus 42 percent). Also, a provision in the federal health care reform law requires private insurers to cover all ACIP-recommended vaccines with no co-pay requirements.

It’s a complex problem, acknowledged Dr. Zimet. For example, based on studies he has done involving the hepatitis B vaccine, he explained, “practical obstacles, like transportation to the clinic and how many children the mom is taking care of at home” can have an impact, particularly on adherence to the three-shot regimen.

A variety of approaches are being tested to increase vaccination rates, many of which are focused on moments or interactions that can influence awareness and decision making. Drs. Zimet and Brewer lead initiatives in their respective states that are part of the national Cervical Cancer-Free America campaign. In North Carolina, Dr. Brewer said, they are focusing their efforts on school-located health centers, where many children already receive other vaccines.

Other studies and programs are testing whether social media and text messaging can be used as educational platforms and reminder systems for adolescents and women.

A Mother’s Attitude Is Key

For younger girls, the available data strongly indicate that a single factor heavily influences whether they get vaccinated: their mother. “The gateway to adoption of the vaccine[s] is through the parents,” Chollette stressed. In particular, she continued, mothers are the key. “The mother’s values play a prominent role in whether girls go to the doctor and get all three doses according to schedule.”

Dr. Carlos and her colleagues are attempting to use cancer screening appointments as “teachable moments” for mothers of adolescent girls. In two separate studies, women undergoing breast and cervical cancer screenings who have adolescent daughters will receive tailored information about cervical cancer and the HPV vaccines. The studies will test different means of providing the information, including using a Web-based platform, and vaccination rates will be tracked via electronic medical records.

“From a public health perspective, it makes perfect sense to target mothers who come in for cancer screening,” Dr. Carlos said. Women undergoing their own cancer screenings “may be more receptive to acting on educational information about HPV prevention,” she continued. “Part of what this study is doing is encouraging this receptivity after being screened, and using that to encourage them to get their daughters vaccinated. The message is: ‘You’ve done something to protect yourself against cancer, so why not protect your daughter against HPV?’”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

November, 2011|Oral Cancer News|

Although Most Smokers Want to Quit… Only a Fraction Actually Do

Source: The Wall Street Journal
Author: Betsy McKay

 

More than two-thirds of American smokers want to quit, but only a fraction actually do, underscoring a need for more services, messages, and access to medications to help them kick the habit, according to a new government report out today.

Nearly 69% of adult smokers wanted to quit in 2010 and more than half tried, but only 6.2% succeeded, according to the Centers for Disease Control and Prevention.  Those who try to quit can double or triple their chances with counseling or medications, but most of those who did try to quit in 2010 didn’t use either. Nor did they receive advice on how to quit from a doctor.

The findings suggest more needs to be done to help smokers quit — particularly certain segments of the population with low quit rates, said Tim McAfee, director of the public health agency’s Office on Smoking and Health, in an interview.

Nearly 76% of African-American smokers wanted to quit last year, and 59% tried — well above the national average, said McAfee. But a mere 3.2% succeeded, which is the lowest rate among measured races and ethnicities. American smokers with college degrees had a far higher rate of success at quitting — 11.4% — than smokers with fewer than 12 years of schooling, who had only a 3.2% success rate.

Still, McAfee said, there are some encouraging signs. For example, the percentage of young adults between the ages of 25 and 44 who want to quit has climbed over the past decade. “We think that’s incredibly important and the influence perhaps of large policy shifts in the U.S.” such as smoke-free laws and excise taxes, he said. (By contrast, interest in quitting in some other countries, such as China, is low.)

State Medicaid programs are now required as part of health reform to pay for smoking cessation services for pregnant women, and the federal government also now allows states to provide coverage for medicines and counseling for other Medicaid recipients.

But “we lost some momentum” in enacting smoke-free laws, McAfee said. Twenty-five states and Washington, D.C., have comprehensive smoke-free laws in place but none has been added to the list so far in 2011. The most recent state to go smoke-free was South Dakota, last November.

A court-ordered temporary halt earlier this week to a government plan to put graphic warning labels on cigarette packs could also set back efforts to get people to smoke, McAfee said.

That’s not only because the images — such as one of a man exhaling cigarette smoke through a hole in his throat — are meant to discourage smoking, but the planned labels also include telephone quitline information. A federal judge ordered the temporary halt after tobacco companies argued it would violate their constitutional right to free speech.

November, 2011|Oral Cancer News|

HPV Vaccine Recommended for Boys aged 11 to 12 Years

Source: HemOncToday.com

The CDC’s Advisory Committee on Immunization Practices today approved routine recommendation in favor of administering the quadrivalent HPV vaccine for boys aged 11 to 12 years.

Committee members decided that the vaccine (Gardasil, Merck) was safe, efficacious and cost-effective enough to warrant routine usage in this population. The recommendation issued in 2009 was permissive, meaning providers could give the vaccine to boys, but it was not routinely administered. This change would put the HPV vaccine into the regular vaccination schedule. The three-vaccination series can start as early as age 9 years.

“The committee recommended that routine vaccination of males aged 11 or 12 years with three doses of quadrivalent vaccine be given to prevent HPV infection and HPV-related disease,” Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a phone call with reporters. “Boys and young men 13 to 21 years of age who have not already received the vaccine should be vaccinated.”

Anne Schuchat, MD
Anne Schuchat, MD

Insurance companies typically cover HPV vaccine in boys, but that is not necessarily the case for a permissive recommendation, according to Schuchat, who said a routine recommendation for a vaccine usually translates into coverage without co-pays.

The committee voted 8-5 with one abstention in favor of recommending vaccination for young men up to age 21 years with permissive recommendation for men aged 22 to 26 years. The committee considered recommending vaccination up to age 26 years, which would have harmonized recommendations for men and women, but concluded that the vaccine was not cost-effective in men aged older than 21 years.

According to the committee, in extending the quadrivalent vaccine to young men, the vaccine was 89% effective against genital warts and 75% effective against precancerous anal intraepithelial neoplasia. Schuchat said the number of girls receiving vaccinations has been disappointing, and there is hope that vaccinating boys will protect both young women and young men.

“HPV vaccination for males offers an opportunity to decrease the burden of HPV-related disease in both males and females,” Schuchat said. “So in addition to providing direct benefit to boys by preventing future genital warts or anal cancer, there’s the potential that vaccinating boys will reduce the spread of HPV from males to females and reduce some of the HPV-related burden women suffer from.”

About 20 million Americans currently have an HPV infection. According to the CDC, an estimated 7,080 men and 14,720 women develop cancers associated with HPV types 16 and 18 every year. An estimated 80% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and nearly all cervical cancers are HPV-related. Roughly 60% of oropharyngeal cancers are associated with HPV, and HPV-related disease costs an estimated $8 billion annually.

Committee staff said vaccinating boys aged 11 to 12 years would cost $24,000 to $62,000 per quality-adjusted life year and would become more expensive per quality-adjusted life year as more girls are vaccinated.

The recommendation will now go to the full CDC. Schuchat said the agency will likely vote on the recommendation in a few months.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

October, 2011|Oral Cancer News|

CDC Committee Recommends Boys Receive HPV Vaccine

Source: CNN.com

A federal government advisory committee voted Tuesday to recommend that boys and young men, from ages 11 to 21, be vaccinated against the human papilloma virus, commonly referred to as HPV.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices says the vaccine series can be started as early as age 9.

Twelve members of the committee voted in favor of a recommendation that 11- and 12-year-old boys be vaccinated; one member abstained.

A separate vote involving males age 13 to 21 was split. Eight voted for it; five voted against, and one abstained. The same recommendation said males age 22 through 26 may be vaccinated.

HPV is the No. 1 sexually transmitted disease in the United States. At least 50% of sexually active people will get it at some point in their lives.

Study: Males should get HPV vaccine too

The HPV votes took place as part of the advisory committee’s meeting in Atlanta, Georgia.

The HPV vaccine is already recommended for females between the ages of 9 and 26 to reduce the risk of cervical cancer. The CDC recommends girls get the vaccine at age 11 or 12.

The FDA approved the first HPV vaccine, Gardasil, back in 2006. The second vaccine, Cervarix, was approved in 2009.

The vaccine is given in three doses. Gardasil also protects against most genital warts and has been shown to protect against anal, vaginal and vulvar cancers, all of which are associated with HPV, according to the CDC.

Although the vaccine has been approved for males since 2009, it hasn’t been as heavily promoted for them.

Increase in oral cancers linked to HPV

One reason for the push now is that girls aren’t getting vaccinated in the numbers doctors expected. “If the boys are also immunized, it reduces the transmission back and forth,” said Dr. William Schaffner, chairman of the Department of Preventative Medicine at Vanderbilt University, who attended the CDC meeting as an adviser but not a voting member.

By receiving the vaccine, boys will also be protected against cancers of the penis and rectum. Also, there is growing evidence of HPV causing the recent increase in head and neck cancer. A study released earlier this month found approximately 70% of all oropharyngeal cancers are caused by HPV infection. The HPV vaccine protects against both, according to Schaffner.

Earlier this year, the American Academy of Pediatrics began including the HPV vaccine on its list of recommended vaccines for boys.

The HPV vaccine became a political hot potato when Republican presidential contender Michele Bachmann was critical of fellow Republican contender and Texas Gov. Rick Perry’s support of the vaccine for girls. In 2007, he signed an executive order that required Texas schoolgirls to receive vaccinations against HPV, although it wasn’t implemented.

The CDC notes that the Food and Drug Administration has licensed the vaccines as safe and effective. “Both vaccines were tested in thousands of people around the world. These studies showed no serious safety concerns. Common, mild adverse events reported during these studies include pain where the shot was given, fever, dizziness, and nausea,” according to the CDC website.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2011|Oral Cancer News|

Rate of HPV Vaccination in Teens Lagging

Source: The Associated Press
Author: Staff

 

Only about half of the teenage girls in the U.S. have rolled up their sleeves for a controversial vaccine against cervical cancer — a rate well below those for two other vaccinations aimed at adolescents.

The vaccine hit the market in 2006. By last year, just 49 percent of girls had gotten at least the first of the recommended three shots for human papilloma virus, or HPV, a sexually-transmitted bug that can cause cervical cancer and genital warts. Only a third had gotten all three doses, the Centers for Disease Control and Prevention said Thursday.

In contrast, the CDC said about two-thirds of teens had gotten the recommended shot for one type of bacterial meningitis and a shot for meningitis and tetanus, diphtheria and whooping cough.

Granted, it can take many years for a new vaccine to catch on and reach the 90 percent and above range for many longstanding childhood vaccines. But use of HPV vaccine has been “very disappointing” compared to other newer vaccines, said the CDC’s Dr. Melinda Wharton.

“If we don’t do a much better job, we’re leaving another generation vulnerable to cervical cancer later in life,” said Wharton.

Why aren’t more girls getting HPV shots? The vaccine can be very expensive, and it can be a bit of a hassle. It takes three visits to the doctor over six months.

But sex no doubt has something to do with it, experts said.

Girls are supposed to start the series when they are 11 or 12 before most girls become sexually active. The vaccine only works if a girl is vaccinated before she’s first exposed to the virus.

But some parents may misunderstand, thinking their daughters don’t need it at such a young age because they aren’t sexually active. Others may believe that it would require a discussion about sex and sexuality a talk they may not feel ready to have, some experts said.

The government needs to be more aggressive about changing those perceptions with a major education campaign, Jeff Levi, executive director of the Trust for America’s Health, a Washington, D.C.-based research group, said in a statement.

Millions of Americans women and men become infected with HPV each year, though most show no symptoms and clear the virus on their own. But some strains persist and can cause genital warts and cancer. About 12,000 women are diagnosed with cervical cancer each year, and about 4,000 die from it, according to CDC statistics.

The new study was based on a 2010 telephone survey of the parents of more than 19,000 adolescents ages 13 to 17, who allowed researchers to check their kids’ vaccination records.

Rhode Island and Washington had the highest HPV vaccination rates, both around 70 percent for at least one shot. Idaho had the lowest rates, at about 29 percent.

The study was published online in a CDC publication, Morbidity and Mortality Weekly Report.

August, 2011|Oral Cancer News|

Are lozenges and other smokeless products safer alternatives to smoking?

Source: Pennsylvania’s Fox News

Tobacco company rep David Howard waxes enthusiastic when he talks about a new product his employer, R.J. Reynolds Tobacco Co., has developed: a pellet of finely cured tobacco, binders and flavoring that dissolves in the mouth in 10 minutes.

Under test market in two U.S. cities — Denver and Charlotte, N.C. — Camel Orbs will join two dissolvable tobacco lozenges already on the market if it graduates to broader distribution. And Howard is optimistic it will.

“These products provide smokers with an option to enjoy the pleasure of nicotine without bothering others,” Howard said. “No secondhand smoke. No spitting. No cigarette butt.”

Dissolvable tobacco consists of small pieces of compressed, finely ground tobacco powder, binders and flavorings that are shaped into pellets, sticks or strips. When placed in the mouth, they dissolve within minutes, providing a nicotine hit.

The tobacco industry says that the products contain far fewer cancer-causing chemicals such as tobacco-specific nitrosamines and are a “harm reduction” strategy that, like electronic cigarettes, might help people turn to less risky tobacco habits or eventually quit smoking.

But public health officials and anti-smoking advocates fear that the products will help initiate a new generation of smokers. The flavoring and packaging appeal to children, they argue, and teenagers will gravitate toward a product they can easily hide.

On Thursday, the Food and Drug Administration will take up the issue with an advisory committee hearing on the effect of dissolvable tobacco products on public health.

“Tobacco companies are always one step ahead of the sheriff,” said Sen. Sherrod Brown (D-Ohio), one of several senators who asked the FDA to review the products. “They have found ways to evade the rules and regulations and public health warnings.”

The first dissolvable tobacco product, a lozenge called Ariva, debuted in 2001. But in the last year the number of products on sale or in test marketing has jumped and major tobacco companies have entered the arena. Reynolds is market-testing two other products, Camel Strips and Camel Sticks, in addition to Camel Orbs. Philip Morris is test marketing a dissolvable tobacco stick.

At the same time, use of smokeless tobacco — snuff, chew, electronic cigarettes and, increasingly, dissolvable tobacco — is growing at a rate of about 7% per year, according to a 2010 report by Research and Markets, an international market research and data company.

In some states, use of smokeless tobacco products among men is almost as high as the national prevalence of cigarette smoking among adults, which stands at 20.8%, according to the Centers for Disease Control and Prevention. Across the U.S., 7% of U.S. adult males use smokeless tobacco, the CDC said.

Use among children is growing too. According to a 2010 survey by Monitoring the Future, an annual nationwide study funded by the National Institute on Drug Abuse, 8.5% of 12th-graders said they had used a smokeless tobacco product in the last 30 days compared with 6.7% in 2003.

“Because it has a mild taste, we’re concerned dissolvable tobacco will be a starter product for kids,” said Matthew Myers, president of the Washington-based anti-smoking group Campaign for Tobacco-Free Kids. “Traditionally, girls have not used smokeless tobacco products. But this product does not have a substantial smell or require spitting. There is a real concern that this product will appeal to adolescent girls, particularly those concerned about weight.”

Public health officials also have expressed concern about the effect on teeth and gums of holding the product in the mouth for 10 to 20 minutes and the effect on the stomach from swallowing the tobacco chemicals.

Few studies have been done specifically on the potential health risks of dissolvable tobacco.

One study, published in March in the Journal of Agricultural and Food Chemistry, tested four dissolvable tobacco products, three of which were being test-marketed, and found they contained mostly nicotine and a variety of flavorings, sweeteners and binders.

Some products contained coumarin, which has been banned as a flavoring agent in foods because of its link to liver damage, said study author John V. Goodpaster, an assistant professor in the forensic and investigative sciences program at Indiana University-Purdue University Indianapolis.

Studies on other smokeless tobacco products show they are considerably less risky than smoking cigarettes and cigars, which raises the risk of lung and a variety of other cancers, respiratory illness and heart disease. However, smokeless products still increase the risk of oral, pancreatic and esophageal cancer as well as heart disease. They can cause gum disease and can be unsafe for a fetus, health experts say.

The lowered risks of dissolvable products should be seen as a positive development, said Brad Rodu, a professor of medicine and chairman of tobacco harm reduction research at the University of Louisville in Kentucky.

“One cannot call any tobacco product absolutely safe,” said Rodu, who said he received funds from tobacco companies to do his research but had no personal ties to any company. “But the health risks of using smokeless tobacco products over the long term are so low that they are barely measurable by modern epidemiological evidence.”

Rodu added that smoking-cessation aids such as nicotine gum and the medication Chantix have limited success and that people who can’t quit should be urged to try safer products.

“We have 45 million smokers in the United States,” he said. “If we had almost any other activity in society that was this dangerous, we would welcome products that were safer.”

Sara Troy Machir, vice president of communications and investor relations at Star Scientific Inc., maker of Ariva and another dissolvable tobacco product called Stonewall, said the Glen Allen, Va.-based company is developing two new products, Ariva BDL and Stonewall BDL, with lower levels of tobacco-specific nitrosamines (BDL stands for “below detection limits”).

Machir said the company was founded with the mission of reducing harms associated with tobacco use and that “we have absolutely no interest in recruiting another generation of tobacco users.”

Star Scientific applied to the FDA last year for approval to market its two new products as “modified risk tobacco products.” To the chagrin of anti-smoking advocates, the FDA announced in March that the products were not subject to regulation under the 2009 Family Smoking Prevention and Tobacco Control Act, which gives the agency the authority to regulate tobacco products.

Twelve senators, including Brown, Jeff Merkley (D-Ore.) and Barbara A. Mikulski (D-Md.), have asked the FDA to reverse its decision.

In April, the FDA announced it was developing a strategy to regulate additional categories of tobacco products and that it would review information on dissolvable tobacco from published studies, manufacturers’ research and the advisory committee meeting this week. The agency is expected to eventually close any loopholes that might prevent dissolvable tobacco products from escaping its jurisdiction.

“It’s very clear dissolvable products are here to stay, and I believe the FDA will have to deal with them,” Rodu said.

Oral Cancer…what does sex have to do with it?

Source: DentistryIQ.com

The answer is … plenty! This issue will focus on oral cancer awareness. While there are many topics we can delve into regarding this dreadful disease, we will focus on a few topics.

We will share two personal and very poignant stories. Kim Anzalotti, Bill Wislon, and Eva Grayzel impart information that will move you and make you think about your daily in-office procedures. JoAnn Gurenlian, RDH, PhD, will share insights on the human papillomavirus, or HPV, a sexually transmitted virus, and its relationship to oral cancer. And last, but certainly not least, Jamie O’Day, Treatment Facilities Coordinator, The Oral Cancer Foundation Inc., The Bruce Paltrow Oral Cancer Fund, will share her insight on oral cancer screening and the need for a thorough examination.

One personal story is shared by Eva Grazel, an international motivational speaker, author, performer, and cancer survivor. I had the pleasure of meeting Eva a number of years ago. In 1998 at age 33, Eva, a non-smoker, saw a number of dentists and physicians for over two years for an “ulcer” on her tongue that became larger and more painful, without any resolution. She was finally diagnosed with advanced oral cancer, Stage IV squamous cell carcinoma, on the lateral border of her tongue.

After the many missed opportunities for diagnosis, Eva was given a 15% chance of survival. While her late stage diagnosis is not uncommon, her recovery was unique, as she beat the odds. After diagnosis, Eva underwent a partial tongue reconstruction, a modified radical neck dissection, and a maximum dose of radiation therapy. The good news is that Eva is very much alive today, and helps to motivate professionals and patients about oral cancer examinations and risk factors. She also authored the Talk4Hope book series, written to inspire children and parents who have a family member with cancer.This Family Book Series helps families cope with their feelings about cancer, enlightens parents on how to communicate with their children, and creates special moments to cherish. Read Eva’s contribution in this eVillage FOCUS issue.

For the 12th year in a row, April was the official oral cancer awareness month in the U.S. Oral cancer awareness means raising public awareness through group collaboration to ensure that oral cancers get the national media attention necessary to highlight risk factors and oral cancer screening. Free oral cancer screenings were held throughout the country. But it does not have to be a special month to conduct oral cancer screenings in the community. There are a variety of forms for editable press releases for events. Conduct your community activity when it is convenient for you.

Rates of oral cancer are on the rise among men, and researchers say the cause is not the use of tobacco and alcohol, risk factors we have been aware of for years. The number of smokers in the U.S. has steadily declined in the past 50 years, according to the CDC, yet the rate of oral cancer has remained relatively steady, and has recently been on the increase. The culprit is the human papillomavirus, or HPV, the sexually transmitted virus responsible for the majority of cases of cervical cancer in women. Approximately 65 percent of oral cancer tumors were linked to HPV in 2007, according to the National Cancer Institute.

The profile of these new cases of oral cancer is non-smokers who are predominantly white, upper middle class, college-educated men. HPV-16, the strain of the virus that causes cervical cancer in women, has become the leading cause of oral cancer in non-smoking men. Oral HPV infection was strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use in this case-controlled study. An even greater than-additive risk has been reported, although inconsistently, for patients exposed to both HPV and tobacco and those exposed to both HPV and alcohol.

A University of North Carolina (UNC) study found the incidence of oral tongue cancer increasing in young, white females, even though overall, incidence of oral cavity squamous cell carcinoma (OCSCC) was decreasing for all ages. The increasing incidence was most dramatic for white females ages 18 to 44. They had a percentage change of 111 percent.

Interestingly, the incidence decreased for African American and other racial groups. They analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and oral tongue squamous cell carcinoma (OTSCC).

 

There is an enormous effort to vaccinate girls and women between the ages of 11 and 26 against HPV, and according to experts, should have included boys and men from the beginning. Gardasil (Merck), one of the two major vaccines used to prevent HPV infection, wasn’t approved for use in males in the United States until 2009, three years after it was approved for women. Men have a greater chance of contracting the HPV virus from oral sex than women do from the same behavior, though researchers are not clear on the reason for this phenomenon. For CDC information on HPV vaccines, visit their website.

 

The other vaccine is Cervarix (GlaxoSmithKline). According to the CDC, both vaccines are very safe, and are made with very small parts of the human papillomavirus (HPV) that cannot cause infection. As with any pharmaceuticals, there can be side effects. For a recently updated Q & A page on these vaccines, visit the CDC website.

In girls and young women ages 9 to 26, Gardasil® helps protect against two types of HPV that cause about 75% of cervical cancer cases, and two more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against 90% of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

While the vaccines available are not approved for prevention of oral cancer, the impact the vaccines may have on oral cancer should be considered. The Oral Cancer Foundation believes that elimination of a causative agent (HPV16), by preventing infection from it by use of a vaccine, will subsequently prevent any disease that agent may have produced in the protected individual. This is simple scientific extrapolation, and a view shared by many in the science community. Makes sense to me!

Oral cancer has a low survival rate because it is generally not discovered until it has spread to other areas, according to the CDC. Only half of people who’ve been diagnosed with oral cancer will live longer than five years. Prevention is the name of the game. Do not use tobacco products, use alcohol in moderation, limit the number of sexual partners and use protection, and screen (or be screened) annually for oral cancer. Anyone old enough to have engaged in sexual behaviors which are capable of transferring the HPV needs to be screened annually for oral cancer. There are many cancer screening protocols available. Education, prevention, screening and early intervention can save lives.

 

Late-stage cancer detection in the USA is costing lives

Source: The Lancet

In the USA, cancer is the most common cause of death in people aged between 49 and 80 years. In 2007, 562 875 cancer deaths were reported, which account for about 23% of all deaths. Cancers of the lung, colorectum, breast, and prostate are the most common and have the highest mortalities. In high-income countries remarkable progress has been made in cancer management and care, and although cancer incidence continues to rise, due to the influences of ageing, lifestyle, and population growth, mortality has fallen and survival rates are improving for several cancers, largely because of advances in screening, early detection, and treatment.

So in light of this progress, the US Centers for Disease Control and Prevention (CDC) report published last week makes for troubling reading, showing as it does that almost half of colorectal and cervical cancers and a third of breast cancers are being diagnosed at a late stage when treatment is less effective. The study is the first nationwide examination of stage-specific cancer incidence rates and screening prevalence for breast, cervical, and colorectal cancer by demographics including age and race or ethnic origin. The study found a lower uptake of screening and the presentation of symptoms late in low-income and ethnic minority communities, who also had longer delays in getting their diagnosis and treatment after an abnormal test. All these factors have been well documented to be associated with a late diagnosis for over a decade, so it is disappointing to see that cancer care is still failing the same patient groups. A further finding was the wide variation in late-stage diagnosis across different locations, which is a sad reflection of the fragmented health-care system in the USA. The CDC also reported that people without appropriate health insurance had less access to services despite the Patient Protection and Affordable

Care Act that is supposed to cover recommended screening tests by supporting people financially through co-payments.

Patient delay can be a major factor behind late diagnosis; many patients are unaware of (or ignore) the symptoms of cancer; and health literacy, cultural attitudes towards seeking medical care, fear and embarrassment of a cancer diagnosis, and difficulties navigating the health-care system all play a part. But physicians can add to delays by failing to recognise sentinel signs and by failing to triage the right patients forward for further investigation. Symptoms of early cancer can be non-specific and mistaken for other conditions, a factor behind the late presentation of ovarian or pancreatic cancers, for example. Biomarkers could have a role in helping to identify and stratify high-risk populations. Education of both the patient and general physician is essential to move to an early diagnosis of cancer. For example, if patients have a family history of certain cancers, such as colorectal or breast cancer, then these individuals can present earlier than might be expected. Both patient and physician should be aware of these indicators and appropriate screening programmes made available to all who need them.

A shortcoming of the CDC report is the lack of discussion about the nature of diagnostic tests and the challenges they present. For colorectal cancer, the fecal occult blood test is not discriminative, and the follow-up tests of sigmoidoscopy or colonoscopy are invasive and not without risk. Although, encouragingly, the recent trial of once-only flexible sigmoidoscopy screening has been shown to be safe and practical. However, overdiagnosis and overtreatment can limit the effectiveness of screening in the general population; thus, identification of high-risk groups is crucial. There is a need for better initiatives to support the development of specific tests for particular cancers and to direct treatment to specific patient groups.

Several initiatives to promote early diagnosis in symptomatic patients are noted in the report and should be credited. The CDC have recently established the Colorectal Cancer Control Program, which provides funding to 25 states and four tribal organisations to promote screening and follow-up care to low-income individuals who are uninsured for screening. The CDC’s National Comprehensive Cancer Control Program provides funding and technical assistance to all states and minority community organisations to develop and implement coordinated cancer control plans to provide a continuum of services including prevention, early detection, treatment, survival, and palliation.

Efforts to identify people most at risk of cancer and those who are difficult to reach must continue to be a priority if the alarming statistics in the CDC report are to improve. More research aimed at improving diagnostic tests and biomarker development would complement and improve early clinical diagnoses, and should go hand-in-hand with the removal of patient and physician barriers to effective cancer care.

December, 2010|Oral Cancer News|

Pertussis reaches epidemic proportions in California; New links identified between vaccine-preventable infections and cancer.

Source: Disabled World

New data from the Centers for Disease Control and Prevention (CDC) show that adults remain largely unvaccinated against preventable infectious illnesses. At a news conference convened today by the National Foundation for Infectious Diseases (NFID), experts in public health, infectious disease, oncology and other medical specialties discussed the data and the health consequences for adults who skip vaccines. They collectively called on all adults and health care providers to improve vaccination rates.

“For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days and inability to meet our daily obligations, to pain, discomfort, hospitalization, long-term disability and death,” said Susan J. Rehm, M.D., NFID medical director. According to Dr. Rehm, by foregoing needed vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.

This problem is evident right now, as pertussis (whooping cough) continues to claim the lives of infants in California, while adults, who are frequently responsible for transmitting the disease to infants, fail to get the one-time pertussis booster vaccine. The impact of other vaccine-preventable infections may not be as immediately apparent, but they are no less important. Other vaccines for adults protect against viruses that cause several types of cancer, reactivation of the chickenpox virus that causes shingles later in life, and infection with bacteria that are the leading cause of community-acquired pneumonia.

New survey results from NFID suggest that doctor/patient communication challenges may be at least part of the problem. While physicians perceive they are encouraging their adult patients to be vaccinated, patients say the topic of vaccination rarely comes up during their doctor visits.

Vaccination rates highest among seniors; lowest among minority groups

In unveiling the adult vaccination data from the 2009 National Health Interview Survey (NHIS), Melinda Wharton, M.D., M.P.H., deputy director of the National Center for Immunization and Respiratory Diseases at the CDC, noted that the highest immunization rates are among older Americans, who tend to be vaccinated against influenza and pneumococcal infections. She suggested that one reason for this might be that older persons tend to have more routine visits with health care providers, providing more opportunities to learn about and adopt good preventive care behaviors.

“A good ongoing relationship with your medical provider is positive for so many reasons,” said Dr. Wharton, “not least of which is that you will have an ongoing opportunity learn about the best ways to stay healthy, including the best preventive care choices like vaccines.”

While adult vaccination rates are showing slow improvement overall, one vaccination trend Dr. Wharton specifically noted is the 7.4 percent decrease in pneumococcal vaccination rate in high-risk adults 19 to 64 years of age. She pointed out that this is not because people are suddenly foregoing this vaccine. Rather, the decrease reflects the recent addition of new risk groups — namely smokers and people with asthma — increasing the pool of people who should get the vaccine. Dr. Wharton called on smokers and people with asthma to check with their physicians or other health care providers about this vaccine.

In addition to generally low adult vaccination rates, Dr. Wharton touched on the problem of racial and ethnic vaccination disparities. While strides have been made to close racial and ethnic gaps, some significant vaccination gaps continue to exist among Whites, Blacks and Hispanics.

Vaccine (age and/or risk status) Non-

Hispanic

White (%)

Non-

Hispanic

Black (%)

Hispanic or

Latino (%)

Tetanus, diphtheria, pertussis (19-64 years) 51 54 49
Pneumococcal (65 years and older) 65 45 40
Pneumococcal (19-64 years, high risk) 18 18 12
Hepatitis B (19-49 years, high risk) 43 44 37
HPV (19-26 years) 20 13 13
Shingles (60 years and older) 11 4 5
Influenza (65 years and older) 69 51 51
Influenza (50-64 years) 42 37 31

The NHIS survey also reported vaccination rates in health care professionals for influenza (up 7 percent, to 53 percent), hepatitis B (up 2.5 percent, to 65 percent) and Tdap (up 1.6 percent, to 58 percent). “It’s gratifying to see health care worker vaccination rates continue to increase,” said CDC’s Melinda Wharton. “By modeling good preventive care behaviors our health care professionals are truly leading the way as good partners in their relationship with patients.” The NHIS vaccination data include anyone employed in a health care occupation or setting. In contrast, physician-only vaccination rates are much higher (>90 percent for influenza) as reported in two separate NFID surveys fielded before and during the current influenza season.

Doctor/patient communication breakdown a factor in low vaccination rates

A dramatic physician-patient communication disconnect was revealed by new data from two NFID surveys. Nearly 90 percent of primary care physicians say they discuss vaccines with their patients, yet in a separate survey of consumers, almost half cannot recall ever discussing vaccines with their physicians. As further evidence of the communication gap between physicians and their patients, 99 percent of physicians say that they or their staff initiates vaccine discussions, but just 44 percent of patients say that is true.

“Busy primary care physicians think they’re doing a good job recommending vaccines, but the survey indicates that patients aren’t getting the message,” suggested Dr. Rehm. “Consumers overwhelmingly said they look to physicians for vaccine recommendations and are likely to act on those recommendations, so it’s clear that we physicians need to be more effective in communicating with our patients.”

Among the positive findings, consumer familiarity with vaccine-preventable illnesses is rising, although still limited. Familiarity with specific vaccine-preventable diseases rose 4 to 12 percent compared with results from a 2009 survey, with the largest increase for pertussis vaccine. The only vaccine-preventable disease not to register an increase in familiarity is pneumococcal vaccine. Consumers also report that they rarely refuse vaccines if their physicians recommend them.

A realized consequence: disease resurgence

The ongoing pertussis epidemic in California demonstrates the danger still posed by diseases once thought to be gone in the U.S. There are reports of more than 6,400 cases so far in California this year, the most since 1958. While pertussis can affect people of any age and in fact, national rates have been rising in adults, it is the infants who adults pass this on to who bear the burden. Ten infants, all younger than three months, have died from whooping cough in California this year.

Patrick Joseph, M.D., a California infectious disease physician who is NFID’s vice president, implored adults to get the one-time booster vaccine, “While the epidemic is in adults, the tragedy is in kids. The situation is grave when babies too young to be immunized are dying.”

Dr. Joseph said this crisis means California doesn’t have the luxury of bringing people along slowly. The time to increase vaccination rates for pertussis is now. The California Department of Public Health recommends pertussis boosters for all adults, including those over 65, a move supported by the CDC’s Advisory Committee on Immunization Practices (ACIP). At its October meeting, ACIP voted to extend pertussis booster vaccination recommendations to include adults 65 and older nationwide.

While California has been hardest hit so far, many other areas have seen increased cases this year, including Ohio, South Carolina, Michigan, Texas, Idaho, upstate New York and the Philadelphia suburbs. Since pertussis knows no boundaries, Dr. Joseph voiced his hope that adults outside his home state would also take notice and seek a Tdap vaccine now to protect themselves and infants around them.

Importance of pneumococcal and influenza vaccines also highlighted

AARP board member Catherine Georges, R.N., Ed.D., reminded adults that the time to get an influenza vaccine is now. “We know it’s important for Americans of all ages to go out now and get the flu vaccine, but it’s even more critical for people 50-plus,” said Dr. Georges, a registered nurse and professor and chair of the department of nursing at Lehman College and the Graduate Center at the City University of New York. “Older Americans are often caring for their children and for older loved ones. Getting vaccinated not only protects you, but also helps protect your family and friends.” Dr. Georges echoed the universal recommendation from CDC for influenza vaccination of all Americans six months and older.

Since pneumococcal infection is an all too frequent complication of influenza, Dr. Georges reminded Americans that, “pneumococcal and influenza vaccines can be given at the same medical visit.” Pneumococcal vaccine is recommended for everyone 65 and older and for younger adults with certain risk factors or conditions like asthma, smoking, heart disease and diabetes. For most people, pneumococcal is a one-time vaccination.

Alarmingly few Americans immunized against debilitating disease of shingles

The lowest vaccination rate for a routinely recommended vaccine is for the shingles vaccine, which is recommended for everyone starting at age 60. Only ten percent of eligible persons have received the shingles vaccine. Not only does the likelihood of getting shingles increase with age, so does the severity of shingles pain, which can last long after the shingles rash has disappeared (this pain is known as post-herpetic neuralgia, or PHN). This pain diminishes quality of life and functional capacity as much as congestive heart failure, a heart attack, type II diabetes or major depression.

Adults in the NFID survey say they are familiar with shingles, but further questioning reveals knowledge gaps; for instance, 42 percent do not know that anyone who has had chickenpox is at risk for shingles. Still, adults are aware of the pain of the disease; 55 percent say they “know someone who has had it and it was terrible.” Unfortunately, only half of adults even know there is a shingles vaccine available and just 16 percent know it is currently recommended for everyone 60 and older.

“Shingles can be a terribly painful and debilitating disease, particularly in the elderly,” said Jeffrey Cohen, M.D., chief of the Laboratory of Infectious Disease at the National Institute of Allergy and Infectious Diseases. “Shingles pain can be very difficult to treat. Current therapies are only somewhat effective and often associated with frequent and problematic side effects, especially in older people, which is why it is vitally important that we educate Americans about the vaccine.”

Vaccines prevent cancer

“Human papillomavirus (HPV) not only causes cervical cancer, but also a growing portion of head and neck cancers,” according to Maura Gillison, M.D., Ph.D, Jeg Coughlin Chair of Cancer Research at the Ohio State University College of Medicine. “Twenty years ago about 40 percent of these cancers were due to HPV; today that number is over 60 percent in the U.S. Even more alarming is that these cancers are happening in younger people without traditional risk factors—smoking and alcohol consumption.”

The hepatitis B vaccine also protects against certain cancers. The hepatitis B virus causes 30 percent of all liver cancers in the U.S. and doubles the risk of non-Hodgkin’s lymphoma. Both HPV and hepatitis B viruses are common. An estimated 70 percent of Americans will be infected with HPV in their lifetime and up to 1.4 million Americans have chronic hepatitis B infection.

CDC recommends HPV vaccine for all women 19 to 26 years of age if not previously vaccinated and recommends the hepatitis B vaccine for all sexually active adults who are not in a long-term, mutually monogamous relationship and others in more defined risk groups.

“I urge everyone to get the HPV and hepatitis B vaccines as recommended,” said Dr. Gillison. “These vaccines are truly life-saving. As a cancer-specialist, I can tell you that prevention is a far better option than treatment. These are not cancers you want to have or want your kids to have.”

About the NHIS data – The NHIS has monitored the health of the nation since 1957. The interviewed sample for 2009 consisted of 33,856 households, which yielded 88,446 persons in 34,640 families.

About the NFID data – The NFID consumer survey, conducted by Opinion Research Corporation (ORC), was based on telephone interviews with 1,013 Americans aged 18 and older when from October 15-18, 2010. The margin of error for the full sample is +/-3 percent. The NFID physician survey, also conducted by ORC, was conducted online with 300 primary care physicians

About the National Foundation for Infectious Diseases – The National Foundation for Infectious Diseases (NFID), a non-profit organization, has been a leading voice for education about infectious diseases and vaccination since 1973. It is dedicated to educating the public and health care professionals about the causes, treatment and prevention of infectious diseases. For more information on vaccines and vaccine-preventable diseases, please visit www.nfid.org and www.adultvaccination.org

November, 2010|Oral Cancer News|

Smokeless Tobacco Rates on the Rise

Source: WebMD

By: Bill Hendrick

Even after a generation of warnings from public health officials about the dangers of tobacco use, about 20% of Americans still smoke cigarettes, a CDC report says. The report also shows the rate of smokers who also use smokeless tobacco, such as chewing tobacco and snuff, is rising.

Using smokeless tobacco can keep the nicotine habit alive, making it even harder to quit than going cold turkey, Terry Pechacek, PhD, of the CDC, tells WebMD.

More Americans are turning to smokeless tobacco because of laws that prohibit smoking in public places such as bars, restaurants, and airplanes — and also because smokeless forms can be used in offices and on the job, Pechacek says.

Immediate Benefits of Smoking Cessation

The tobacco companies market smokeless tobacco as a substitute for smokers, but they don’t help people quit smoking, Pechacek tells WebMD.

“We are making no progress in getting people to quit smoking,” he says. “This is a tragedy. Over 400,000 people are dying prematurely and won’t be able to walk their children down the aisle or see their grandchildren.”

Contrary to common beliefs of smokers, the benefits of quitting start immediately, Pechacek tells WebMD.

“We see lower rates for heart attacks within months of quitting,” he says. “And lower rates for lung cancer, too. Stopping a decline in lung function is one of the biggest benefits of quitting smoking.”

The national smoking prevalence rate was 20.6% in 2008 and 2009. About 23% of males smoke, compared to 18.3% of females.

“We are not making progress and we are going to have this burden for tobacco-related diseases for decades to come,” Pechacek tells WebMD.

Who’s Using Smokeless Tobacco

The CDC report says the use of smokeless tobacco is “predominantly a problem among men, young adults, those with a high school education or less and in some states with higher smoking rates.”

Smoking prevalence varies widely among states and territories, from 25.6% in Kentucky and West Virginia and 25.5% in Oklahoma to 9.8% in Utah, 12.9% in California and 14.9% in Washington.

Smoking prevalence was 6.4% in the U.S. Virgin Islands, 10.6% in Puerto Rico, and 24.1% in Guam.

Smoking prevalence for men was significantly higher than for women in 15 states, plus Guam and Puerto Rico. Smokeless tobacco use was highest in Wyoming at 9.1%, West Virginia at 8.5%, and Mississippi at 7.5%. It was lowest in California at 1.3% and Massachusetts and Rhode Island at 1.5%.

Among findings and conclusions in the report:

  • Smokeless tobacco use was most common among those aged 18 to 24.
  • Smokeless tobacco use decreased with higher educational attainment.
  • Among the 25% of states in which smoking prevalence was greatest, seven also had the highest numbers for smokeless tobacco use, Alabama, Alaska, Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia.
  • Doctors, dentists, and others in their offices should encourage patients to quit smoking and help them find ways to do so.

CDC Director Tom Frieden, MD, MPH, says it’s unfortunate that so many smokers also are using smokeless tobacco products, which “may keep some people from quitting tobacco altogether.” He says in a news release that anti-tobacco efforts need to be beefed up against all forms of use.

Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health, says in the news release that the new numbers showing smokeless tobacco use “are concerning” and that officials “need to fully put into practice effective strategies, such as strong state laws that protect nonsmokers from secondhand smoke, higher tobacco prices, aggressive ad campaigns that show the human impact of tobacco use and well-funded tobacco control programs, while stepping up our work to help people quit using all forms of tobacco.”

Tobacco Use State by State

Here’s a list of percentages of smokers who also use smokeless tobacco, by state, from lowest to highest.

State                   Percentage

Delaware                   2.9

Washington, D.C.     3.0

Rhode Island            3.0

California                  3.2

Maryland                  3.6

Massachusetts        4.1

New Jersey              4.4

Maine                        4.7

Louisiana                  4.8

Illinois                        5.2

Nevada                     5.2

New York                  5.2

Arizona                      5.7

Hawaii                       5.7

Connecticut              5.8

Colorado                  6.1

Wisconsin                6.1

Georgia                    6.4

Ohio                          6.5

Tennessee              6.5

North Carolina        6.6

Florida                     6.7

New Mexico           6.8

Nebraska               6.9

Missouri                 7.0

South Carolina      7.0

Pennsylvania        7.1

Kansas                  7.5

Kentucky               7.7

Washington          7.8

Indiana                  8.0

Vermont                8.1

Iowa                      8.3

West Virginia       8.3

Texas                   8.4

Mississippi           8.5

Oregon                 8.7

South Dakota       8.7

Alaska                   8.8

New Hampshire   9.2

Oklahoma             9.2

Idaho                      9.6

Alabama                9.8

Michigan               9.9

Minnesota           10.5

Virginia                10.5

Utah                    10.9

Arkansas            11.7

North Dakota     11.8

Montana             12.1

Wyoming            13.7

Puerto Rico          0.9

Guam                    3.2

Virgin Islands      4.2

November, 2010|Oral Cancer News|